02/03/2015 05:15 pm ET Updated Apr 05, 2015

Behind the Curtain With Dr. Oz


Recently, an article in the British Medical Journal concluded that evidence supported only 46 percent of the recommendations made on the Dr. Oz show. Headlines proclaimed, "More than half of Dr. Oz's advice is baseless or wrong!"

What this study didn't mention is that less than half of conventional medical care -- what your doctor tells you -- is based on randomized controlled trials and strong scientific evidence. Much less.

For example, the joint cardiovascular practice guidelines of the American College of Cardiology (ACC) and the American Heart Association (AHA) have become important documents for guiding cardiology practice and establishing benchmarks for quality of care. An article in the Journal of the American Medical Association reviewed these guidelines and concluded that only 11 percent of the 2,711 guidelines met the A-level of evidence (i.e., strong evidence from randomized controlled trials) and 48 percent met the C-level of evidence (i.e., based on the personal opinions of experts in the field).

Not so different than the Dr. Oz level of evidence.

No one has a monopoly on truth, and science continues to advance. Yesterday's heresies may be tomorrow's conventional wisdom. As the chief of medicine at the Harvard Medical School and the Massachusetts General Hospital said on my first day of internship, "Half of what you learn here will be out of date by the time you finish your medical training; the problem is knowing which half." A little humility goes a long way.

Perhaps ironically, this pie chart came from the British Medical Journal's own Clinical Evidence website. This chart indicates that, of about 2,500 conventional medical treatments supported by good evidence, only 15 percent of treatments were rated as beneficial, 22 percent as likely to be beneficial, 7 percent part beneficial and part harmful, 5 percent unlikely to be beneficial, 4 percent likely to be ineffective or harmful, and in the remaining 47 percent the effect of the treatment was "unknown." The text says, "The figures suggest that the research community has a large task ahead and that most decisions about treatments still rest on the individual judgments of clinicians and patients."

A busy heart surgeon may perform 25,000 operations in his or her lifetime. In one show, Dr. Oz reaches almost 3 million people with information that can make a meaningful difference in their lives and staying healthy.

He has taught millions of people the basics of a healthy lifestyle: eat well, stress less, move more, love more. He teaches fundamental concepts that make an enormous difference like maintaining a healthy blood pressure, blood sugar, and weight, metrics that are important drivers of reducing chronic diseases and increasing life spans. While there are oceans of data defining ailments like these, it is the practical and often unproven day to day tips affecting behavioral change that audiences are seeking.

A typical piece of sensible advice from these shows might be to sneeze into the crook of your elbow, a tip also shared by the Centers for Disease Control. Unfortunately this is an unproven recommendation. When health media delves into alternative medicine, the advice becomes even more difficult to "prove" because these traditions do not neatly fit into the randomized clinical trials that we value in conventional medicine. Yet many of these "unproven" concepts are inherently accepted by medical professionals.

Even the authors of the British Medical Journal article were concerned by how the media reacted to their article. They wrote on the BMJ web site:

As an aside, we are somewhat disappointed that the overwhelming commentary seems to be that our study somehow proves that Dr. Oz or the Doctors are quacks or charlatans or worse. Our data in no way supports these conclusions...

Some of these recommendations may seem reasonable (e.g. "If you have the flu: Get rest, drink fluids. For the whole year getting enough sleep and not too run down is important for general health"), but they are not supported by research studies.

This leads to an important caveat that may not have been understood by all those who reported on this study. Although, a particular recommendation may lack evidence this doesn't necessarily mean the recommendation is ineffective or harmful. All we can say is just that we don't have evidence for or against the recommendation.

Implying that absence of a citation in an academic journal means medical advice has no merit is a misleading premise and misses a truth that practicing physicians acknowledge -- at least half the time that we are faced with a clinical decision, strong scientific evidence is lacking. We make these decisions based on our life experience as clinicians and our familiarity with the individual patient. Patients trust this "best guess" because it represents an expert opinion and takes into account our cumulative lifetime of first hand subjective experiences with other patients.

I realize this truth is unsettling, but healing relationships are built on transparency. Let's all be more humble about the evidence behind medical advice, but also respect the challenges to providing accessible lifestyle guidance. Just like navigating in the open sea, triangulating the information you collect from media with your doctor's advice and some common sense will help map a sound path to safety.